Angiotensin receptor blocker and angiotensin-converting enzyme inhibitor use and survival in gastric cancer patients: a Finnish nationwide cohort study

TL;DR

This study finds that using angiotensin receptor blockers may improve survival in gastric cancer patients, based on a large Finnish cohort.

Contribution

The study provides clinical evidence that ARB use is associated with reduced mortality in gastric cancer patients.

Findings

ARB use was linked to a 19% reduction in overall mortality among gastric cancer patients.

Higher ARB dosage was associated with greater survival benefits.

Both ARB and ACEI use showed protective effects on disease-specific survival.

Abstract

The renin–angiotensin system (RAS) has been increasingly recognized to be associated with carcinogenesis and cancer progression. There is extensive preclinical evidence suggesting the benefits of RAS-inhibiting drugs, such as angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs), in preventing the progression of gastric cancer (GC). However, clinical evidence supporting the positive effects of ARBs and ACEIs on GC prognosis is currently limited. The purpose of this study is to investigate their effects in a Finnish cohort.

This is a retrospective national cohort study, where cancer patient registry data were linked to prescription purchase records for ARBs and ACEIs. The effect of ARB/ACEI in the post-diagnostic period on overall mortality was assessed using Cox regression analysis. Disease-specific mortality associations were evaluated with the Fine and Gray model.

We included 2246 histologically confirmed GC patients diagnosed between 2011 and 2016. Follow-up continued until the end of 2023. In the main analysis, a protective effect of ARB use was associated with a significant reduction in overall mortality (adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69–0.94, p = 0.007). Furthermore, the effect was greater for those with higher ARB dosage. A similar finding was not observed with ACEI use. For disease-specific survival, both ARB and ACEI use had a significant protective effect (adjusted HR 0.75, 95% CI 0.62–0.90 p = 0.002 and adjusted HR 0.76, 95% CI 0.63–0.93, P = 0.007, respectively).

Our study adds to the evidence that ARB use might have a beneficial impact on survival among GC patients.

The online version contains supplementary material available at 10.1007/s10120-025-01662-2.

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